Treatment of Tibial Shaft Fractures by Percutaneous K??ntscher Nailing

Intramedullary nailing of the tibia is a controversial procedure for fractures of the tibial shaft. Experience with 50 fractures (58% acute, 8% pathologic, and 34% unsuccessfully treated previously by other methods) with an average follow-up period of one year proved that tibial Küntscher nailing is effective. Mean time to clinical union, with patients independently ambulatory and resuming all work activity, was 29 weeks. Union was demonstrated radiographically at 13 weeks. The major complications were delayed union (2 patients), nail protrusion at the knee (2 patients), osteitis (1 patient), and thrombophlebitis (1 patient). Antirotation wires were used in addition to a Küntscher nail for fractures with inherent rotational instability. Blocking screws were used for fractures predisposed to bending. Technical problems arose most often at the nail entrance site, in negotiation of Herzog's curve, and in selection of proper nail length and caliber. With experience and technical skill, even highly complex tibial fractures can be successfully treated by this method.